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Purulent otitis media--a "silent" source of sepsis in the pediatric intensive care unit

M Persico, G A Barker, D P Mitchell

    Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
    |June 1, 1985
    PubMed

    Insights

    Pediatric intensive care unit (ICU) patients with nasotracheal tubes frequently develop middle ear effusion (MEE). Daily pneumatic otoscopy is crucial for early detection and management of MEE in these high-risk patients.

    Area of Science:

    • Pediatric Intensive Care
    • Otolaryngology
    • Infectious Disease

    Background:

    • Septicemia is a common complication in pediatric intensive care unit (ICU) patients with nasotracheal tubes.
    • Middle ear effusion (MEE) is a frequent, yet often overlooked, cause of septicemia in this population.
    • Pneumatic otoscopy is not routinely performed in these critically ill patients.

    Purpose of the Study:

    • To evaluate the incidence of MEE in pediatric ICU patients with nasotracheal tubes.
    • To assess the diagnostic value of daily pneumatic otoscopy in this patient group.
    • To determine the relationship between MEE and septicemia in nasotracheally intubated children.

    Main Methods:

    • A prospective study involving 46 pediatric ICU patients with nasotracheal tubes, monitored daily with pneumatic otoscopy for 11-98 days.
    • Comparison with 25 control patients without nasotracheal tubes (12 with nasogastric tubes).
    • Myringotomy performed upon positive blood cultures to identify pathogens.

    Main Results:

    • Middle ear effusion (MEE) was significantly more frequent in patients with nasotracheal tubes (87%) compared to controls (23%).
    • MEE occurred initially on the side of nasotracheal tube placement.
    • Bloodstream bacterial isolates matched middle ear pathogens in 80% of affected patients.
    • Nasogastric tubes did not significantly contribute to MEE development.

    Conclusions:

    • Nasotracheal intubation is associated with a high incidence of middle ear effusion (MEE).
    • Daily pneumatic otoscopy should be incorporated into the routine examination of pediatric ICU patients with nasotracheal tubes.
    • Early detection of MEE via pneumatic otoscopy can aid in managing and preventing septicemia in this vulnerable population.

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